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                         PROCEDURE FOR DELIVERY
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  Delivery
  --------
  During contractions, the labouring mother, should be encouraged to grasp
  her knees, ben her head forward, hold her breath and push, and then 
  relax and pant between contractions.

  Eventually, the perineum will be distended, a bulge will appear and,
  during the contractions, you will see the baby's head at the entrance
  of the birth canal - it will recede between contractions. This indicates
  that the birth is imminent.

  More of the baby's head will appear with each contraction. You must
  steady the baby's head as it emerges because whilst in the birth canal
  it is subjected to great pressure from the contractions. If it is 
  allowed to "shoot out" the sudden change in pressure can rupture blood
  vessels in the baby's brain. This may result in brain damage. Do not
  pull on or twist the baby's head.

  Check as soon as possible whether or not the umbilical cord ( a soft
  thick, gelatinous-looking rope ) is around the baby's neck. If it is,
  DO NOT PANIC. Gently try to ease it over the baby's head. DO NOT PULL
  IT.

  If the bag of fluid in which the baby is lying inside the mother has not
  broken properly before birth, there may be a covering membrane over the
  baby's face as it emerges. This must be torn away as soon as possible
  to prevent asphyxia and to allow the fluid to escape.

  
  1: Place a clean pad over the back passage (anus). If a bowel movement
     occurs, wipe it from front to back to avoid soiling the birth canal.

  2: Gently support the baby's head as it emerges and steady it to prevent
     it "shooting out."  DO NOT PUT YOUR FINGERS INTO THE BIRTH CANAL.

  3: When the widest part of the head has passed through the birth canal,
     tell the mother to open her mouth and pant. Support the baby's body
     as it is born.

  4: One the baby is born, lift it onto the mother's abdomen and clear out
     it's mouth. ( see Care Of Newborn Baby - below )

     Hold the baby very carefully because it will be very slippery. Lay it
     down so that the head is lower than the body. Make sure the mother
     and baby are covered and warm.


     Care Of Newborn Baby
     ---------------------

   As soon as the baby has emerged, open it's mouth and wipe away any
   blood or fluid with a swab. By this time it will probably be crying
   and it is quite possible for you to clean it up a little more. Wrap
   the baby up in something sterile, soft and warm. Make sure that the
   head is pointing down, so that any fluid or mucus can drain from the
   mouth and nose, and ensure the airway is kept clear.

   The baby can be allowed to suck at the breast if the mother desires.


     The Non-Breathing Baby
     ----------------------
 
   Occasionally the baby does not cry and if it is not breathing, there
   may be an obstruction in the airway. This is usually mucus and must
   be cleared immediately.

   1: Carefully clear the baby's airway, wiping the mouth and the nose.
      
   2: If the baby fails to respond and is either blue or white and
      completely limp, then begin resusitation immediately ( see part 1
      Resusitation ).

     The Third Stage
     ----------------

   At any time between 10 and 30 minutes after the birth of the baby, the
   afterbirth should seperate from the mother's womb. When it is about to
   be expelled, the mother will experience mild contractions. Encourage
   her to hold her breath and push the afterbirth out. She will find this
   easiest if she is lying down with her knees up and apart. DO NOT pull
   the afterbirth or the cord whilst it is being expelled.

   There is no need to seperate the afterbirth from the cord, this can 
   safely be left until medical assistance is available. keep it intact,
   prefably in a plastic bag, as it will have to be checked for
   completeness when the mother reaches hospital.

   Even a small peice left inside the mother can cause complications 
   later. When the afterbirth ahs been expelled, clean up the mother
   and lay a sanitary towel or clean cloth over the vagina. Make her as
   comfortable as possible and encourage her to rest. A small amount of
   bleeding is normal. Severe bleeding rarely occurs, but, if this does
   happen, remember that skilled help is on the way so DO NOT PANIC.

   Gently massage the mother's abdomen just below the navel to stimulate
   the uterus to contract. The uterus will harden as it contracts but
   continue to massage till skilled help arrives.

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